title: Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery.
abstract: Preoperative computed tomography (CT) use appears to be increasing among patients undergoing cardiac reoperations. We hypothesized that preoperative CT imaging reduces adverse outcomes and operative mortality for these patients. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. Patients were stratified according to those with preoperative CT imaging (CT, n=140) and to those without preoperative CT imaging (NCT) (NCT, n=233). Preoperative risk, operative features, and postoperative outcomes were evaluated. Operative mortality for all cardiac reoperations was 7.5%. Patient risk factors were similar between CT and NCT groups. Preoperative imaging was more commonly performed for reoperative isolated valve operations (CT=70% vs. NCT=55.8%, P=0.01) but less commonly performed for reoperative isolated coronary artery bypass grafting (CABG) operations (14.3% vs. 22.7%, P=0.05). Postoperative renal failure, prolonged ventilation and operative mortality were similar between groups. Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15-36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 2908, USA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: Lapar
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.forename: James N
authors.initials: JN
authors.lastname: Irvine
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011300:Preoperative Care; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014768:Virginia